Validation of Bengali version of EORTC QLQ-SWB32: A standalone measure of spiritual wellbeing for advanced cancer patients receiving palliative care.

Background: Spiritual wellbeing (SWB) is one of the crucial components of holistic care for patients with terminal illnesses. The use of a validated instrument can help health professionals approach this difficult and subjective topic. There is no validated Bengali tool to measure this domain. Our study aimed to translate the EORTC QLQ SWB32 tool into Bengali, validate it among advanced cancer patients in Bangladesh, and compare the study's findings to international validation studies to determine its suitability as a measurement and intervention tool for these patients. Methods: The original English version of the tool was translated in Bengali and back-translated by four independent translators with good command in both languages. After approval from the EORTC translation team and linguistic validation, the tool was further validated among 163 advanced cancer patients from palliative care units of four tertiary-level hospitals in Bangladesh. Reliability was tested with Cronbach's alpha, and construct validity was determined by exploratory factor analysis. Known group comparisons were performed by the Kruskal-Wallis H test and the Mann-Whitney U test. Result: Ten adult cancer patients (two female and eight male, three Hindu and seven Muslim) participated in the linguistic validation. Six out of ten participants found the measure understandable and acceptable. A total of 163 advanced cancer patients participated in the psychometric validation phase. The majority of those participants were Muslims (94 %), with a slight male predominance. The internal consistency of each scale was satisfactory (0.7). Exploratory factor analysis also showed similarity to the original scale except item 12 (able to forgive others), which was loaded in both the EX and RO components (0.813 and 0.544, respectively). Older patients had a better relationship with themselves and a lower level of existential fulfilment than the younger group. Patients who tried to find comfort in their religion or spiritual faith, actively performed religious rituals, and had affiliations with religious or spiritual communities showed significantly higher global SWB. Conclusion: The Bengali version of the EORTC QLQ-SWB32 is a reliable and valid tool for measuring the spiritual wellbeing of advanced cancer patients receiving palliative care.

Validation of the Bengali version of the Caregiver Collusion Questionnaire: A tool for measuring collusion among caregivers of terminally ill patients.

Background: In palliative care settings, collusion or "conspiracy of silence" frequently interferes with communication and interpersonal relationships among patients, caregivers, and healthcare professionals. The "Caregiver Collusion Questionnaire" is the only tool available for assessing caregiver collusion. The purpose of the study is to translate and adapt the English version of this instrument into Bengali, followed by standard validation. Methods: The study was carried out in two stages. Four independent translators conducted forward and backward translations of the English version of the "Caregiver Collusion Questionnaire" into Bengali. The Bengali version of the instrument was finalized following expert committee reviews, pre-testing, and cognitive debriefing. The final validation was carried out among 71 caregivers of patients with advanced incurable illnesses admitted to the palliative medicine and internal medicine departments of two Bangladeshi hospitals. In the final phase, the validity (content, face, and construct validity) and reliability (interclass item-wise correlation coefficient) of the translated tool were assessed. Result: 60% of the participants fully understood 19 items, whereas 40% struggled with one or more items. The expert committee expressed their satisfaction with the face and content validity of the translated version. The Bengali version also had quite good reliability (α = 0.62). Seven components were identified using principal component analysis with the distribution of Varimax Rotation distribution. Items under each factor had adequate factor loading, ranging from 0.4 to 0.8. Conclusion: The Bengali version of the "Caregiver Collusion Questionnaire" was found valid reliable and culturally acceptable for measuring caregiver collusion among the Bengali-speaking people. Based on the scale, the reasons for collusion can be identified and measures can be taken for breaking the collusion.

Coping strategy among the women with metastatic breast cancer attending a palliative care unit of a tertiary care hospital of Bangladesh.

BACKGROUND: Breast cancer is one of the leading cancers among the Bangladeshi women. Coping helps these patients to adjust with this life-changing disease. Each individual has unique and different coping mechanism. But we know a little regarding their coping strategies. This study aims to explore the different coping strategies adopted by the women with metastatic (stage IV) breast cancer attending the palliative care unit and their relationship with the common mental health issues like anxiety and depression. METHODS: This cross-sectional study was conducted among 95 patients with metastatic (stage IV) breast cancer attending the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Bangladesh from April 2021 to September 2021. Data was collected by face-to-face interview using a structured questionnaire adapted from Hospital Depression and Anxiety Scale (HADS), Brief COPE inventory and Eastern Cooperative Oncology Group (ECOG) performance scale. Pearson correlation test was used to find the relationships between various domains of coping strategies and psychological variables. Correlation matrix was done to observe the internal correlation among different coping strategies. Kruskal-Wallis H test was done to find the relationship between different coping strategies and ECOG performance status. RESULT: The mean age of the respondents was 48.9 ± 9.9 years. Most of them were married (94.7%), Muslim (92.6%) and homemakers (82.1%). Commonly used coping strategies by the patients were: acceptance (median 10; IQR 10), religion (median 9; IQR 8-10) and instrumental support (median 9; IQR 6-10). Significantly strong positive correlation was found between emotional and instrumental support (R = 0.7; p = 0.01), planning, acceptance and active coping (R = 0.7; p = 0.01); behavioral disengagement, self distraction and denial (R = 0.5; p = 0.01). Significantly fair negative correlation was observed between active coping and depression (R = -0.4, p <0.001). Patients with better performance status on ECOG scale (Grade 0-2) leaned more on the positive coping strategies like instrumental support, emotional support, positive reframing and venting. CONCLUSION: Different coping strategies, especially positive coping helps the patients to adapt with their disease over time. All women suffering from breast cancer should be routinely screened and assessed for psychological distress and ensure early intervention and management to promote a better quality of life.

Depression, anxiety, and performance status among the women with metastatic breast cancer receiving palliative care in Bangladesh: A cross sectional study.

Background and Aims: Advanced breast cancer patients suffer from various psychological issues including depression and anxiety. This study aims to explore these psychological issues and their relationship with the performance status. Methods: This cross-sectional study was conducted among 95 patients with metastatic breast cancer attending the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Bangladesh from April 2021 to September 2021. Data was collected by face-to-face interview using a structured questionnaire along with Hospital Depression and Anxiety Scale. The performance status of the patients was determined by the Eastern Cooperative Oncology Group (ECOG) performance scale. The association between different variables were assessed by χ 2 test and Fisher Exact test. Result: Mean age of the respondents was 48.9 ± 9.9 years. Most of them were married (94.7%), muslim (92.6%) and homemakers (82.1%). More than half (52.6%) of the patients were evaluated having ECOG performance status grade II. Four out of ten  (44.2%) patients had moderate to severely anxiety, and almost one-third (36.9%) patients were suffering from moderate to severe depression. The patients with high educational status were found to have less depression. In addition, patients faring better on ECOG performance scale (Grade 0 to I) had significantly (p < 0.05) less depression and anxiety. Conclusion: Depression and anxiety are one of the major psychological sufferings among the women with metastatic breast cancers. All women suffering from breast cancer should be routinely screened and assessed for phychological distress and ensure early intervention.